Provider Demographics
NPI:1184636771
Name:MEMPHIS INTERNAL MEDICINE AND PEDIATRICS
Entity Type:Organization
Organization Name:MEMPHIS INTERNAL MEDICINE AND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-276-0249
Mailing Address - Street 1:PO BOX 40947
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0947
Mailing Address - Country:US
Mailing Address - Phone:901-255-5220
Mailing Address - Fax:901-255-5223
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:#585
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-276-0249
Practice Address - Fax:901-276-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731080Medicaid
DD9385OtherRAILROAD MEDICARE
MS01271360Medicaid
TN3731080Medicaid